Evaluating The Best Practices As You Consider Hospital Employment. The Business of Medicine for Residents, Fellows and Nurse Practitioners.
With many of the issues created by the pandemic—the massive disruption to hospital operations, its impact on medical practices, and the unique alterations to the way patients receive treatment, and the shake up to resident and fellowship programs, among others—on the wane, the employment of physicians by hospitals is gearing back up. Given what we’ve witnessed over the last 16 months, making a decision about employment (hospital or private practice) requires a wider range of considerations and an expanded checklist as you vet opportunities.
I have written before about the need to take a long look at the proforma that has been prepared for your “new” practice, carefully studying the predictions of patient flows and testing these assumptions against how things fared for the last physician hired. This is now complicated by the impact of the pandemic. So a year’s worth of data might not provide the good information you are looking for, but the last four months of the last-hired’s numbers would be of value. If their practices are not growing you might want to ask why, and approach it from a different angle.
Look solely at the successful practices and the doctors part of them.
Ask your prospective employer who were the physicians whose practices seemed to suffer the least during the pandemic. If it’s a group, check out the top performers. If it’s with a hospital, ask who did the best system wide—go beyond the market you will be working within in a wider search for data.
Who had the best patient visit totals? Was it through telemedicine? What has happened in the last four months if so? Have visits started back up? What is the prediction on telemedicine visits—will they drop off completely or level out?
What about diagnostic equipment? Is there anything being used at successful practices that is not what you will have available? Why not? Has anyone done an ROI calculation to justify a purchase? Would it improve patient retention and development in your market area? What have those using it marketed the service or procedure?
Ask who has been able to retain staff and what the philosophy was in the decision. I’ve seen practices that cut valuable, ingrained staff, only to struggle trying to rebuild overall operations as patient volumes picked up. And I’ve seen groups who made a wise decision to invest in their staffs during the pandemic, taking pay cuts as opposed to losing valuable staff who had years of operational experience and great value; as things have ramped back up they’ve been the best position to grow and rebuild their practices.
(And while you’re on the subject of staff, find out how you can be involved in vetting any staff hired to work with you. Best to ask about staff recruitment since it appears the costs of mid-levels and office staffs have increase significantly in many larger markets, with signing bonuses and good benefits package now needed to recruit the best people.)
Don’t just find out who is the best in your specialty at the group practice or working within the hospital’s employed physicians. Demand an audience with these doctors, even if their market is miles away from yours. Visit the practice, spend a few hours shadowing, and take the time to talk with the mid-levels and, as important, the back office staff and practice manager. These people are the heart and soul of any practice, and how they’ve been engaged with the pandemic can provide a lot of lessons on what to do both the right and wrong ways.
Expand all aspects of how you consider the opportunities. It’s more confusing now, with many of the business aspects of medical practices still in flux or recovery. That requires more diligence, asking more questions, and talking with those who’ve been successful in weathering the pandemic and are rapidly growing their practices to prior volumes and levels of patient satisfaction.
My apologies for the delays in my blogging. Frankly, I’ve been busy responding to a wide range of physicians who are moving to private practice, a welcome phenomenon attributable in large part to the impact of COVID. I’ll tackle this subject in the next blog post. ---Tom Ellis III
I welcome your comments and thought. Please send to me at firstname.lastname@example.org